Nakamura Mashio, Miyata Tetsuro, Ozeki Yasushi, Takayama Morimasa, Komori Kimihiro, Yamada Norikazu, Origasa Hideki, Satokawa Hirono, Maeda Hideaki, Tanabe Nobuhiro, Unno Naoki, Shibuya Takashi, Tanemoto Kazuo, Kondo Katsuhiro, Kojima Tetsuhito
Department of Clinical Cardiovascular Research, Graduate School of Medicine, Mie University.
Circ J. 2014;78(3):708-17. doi: 10.1253/circj.cj-13-0886. Epub 2014 Jan 7.
Epidemiology and clinical management of acute venous thromboembolism (VTE) are not readily available in Japan.
The Japan VTE Treatment Registry (JAVA) is a multicenter cohort study of consecutive patients with an objectively confirmed, symptomatic acute pulmonary embolism (PE), symptomatic acute deep vein thrombosis (DVT), or asymptomatic acute proximal DVT. Of the 1,076 patients enrolled with acute VTE, 68.7% presented with an isolated DVT; 17.0% had PE alone; and 14.4% had both. VTE management was characterized by a high rate of inferior vena cava filter insertion (40.6%), frequent thrombolysis (21.1%), and sub-therapeutic unfractionated heparin-based anticoagulation, followed by warfarin prescription, mostly targeting an international normalized ratio of 2.0 (range, 1.5-2.5). During a mean observation period of 252.5 days, 29 recurrent cases of VTE were documented, yielding an incidence rate of 3.9 per 100 patient-years. A total of 123 patients died during the study period, corresponding to a rate of 16.6 deaths per 100 patient-years. The incidence of major bleeding was 3.2% per patient-year, including 2 fatal hemorrhages and 7 intracranial hemorrhages.
VTE management in Japan is characterized by a highly aggressive strategy in the acute phase, in contrast to protocols that use low-level anticoagulation. The VTE recurrence rates in Japan and Western countries are similar, but mortality is higher in Japan, with significant variability depending on patient and management characteristics.
在日本，急性静脉血栓栓塞症（VTE）的流行病学和临床管理情况尚不清楚。
日本VTE治疗登记研究（JAVA）是一项多中心队列研究，纳入了连续的、经客观证实的有症状急性肺栓塞（PE）、有症状急性深静脉血栓形成（DVT）或无症状急性近端DVT患者。在1076例急性VTE患者中，68.7%表现为孤立性DVT；17.0%仅有PE；14.4%两者皆有。VTE管理的特点是下腔静脉滤器置入率高（40.6%）、频繁溶栓（21.1%）以及基于普通肝素的亚治疗剂量抗凝，随后使用华法林，大多数目标国际标准化比值为2.0（范围1.5 - 2.5）。在平均252.5天的观察期内，记录到29例VTE复发病例，发病率为每100患者年3.9例。研究期间共有123例患者死亡，死亡率为每100患者年16.6例。主要出血发生率为每年3.2%，包括2例致命性出血和7例颅内出血。
与采用低强度抗凝的方案相比，日本的VTE管理在急性期采用高度积极的策略。日本和西方国家的VTE复发率相似，但日本的死亡率更高，且因患者和管理特征存在显著差异。
